APPLYING THE CARE SETTING TRAJECTORY DATABASE TO STUDY END-OF-LIFE OUTCOMES IN PERSONS WITH DEMENTIA

Abstract This study highlights an application of the care setting trajectory database and our new, harmonized, self-reported race/ethnicity variable to evaluate the impact of home health care on later use of hospice and place of death in a large cohort of Medicare decedents. This study evaluated home health care use during the last 3 years of life as a predictor of death in the care of hospice for a cohort of 895,526 Medicare beneficiaries with dementia who died in 2019. The cohort was limited to beneficiaries continuously enrolled for at least 5 years, who were age 40 and older, and who lived in the U.S. fifty states, District of Columbia, or Puerto Rico at death. Co-variates included number of acute hospitalizations during the last 3 years of life, age at death, sex, race/ethnicity, comorbidities, insurance, rural/urban area, and state of residence. 54.5% of the cohort used home health care at any point during the last 3 years of life. Compared to beneficiaries who did not use home health care, those who received home health care were more likely to die at home (64.5% vs. 60%, OR 1.08) or in the care of hospice (65% vs. 58%, OR 1.05). Among beneficiaries who died with hospice, use of home hospice was more prevalent for those who had previously used home health care (53% vs. 49%). This study provides compelling evidence of the value of home health care as a strategy to improve end-of-life care quality among Medicare beneficiaries living with dementia.

resulting in poorer health outcomes for older adults with hearing loss.Additionally, despite a high prevalence of hearing loss, less than 20% of those who could potentially benefit from hearing healthcare use hearing aids, potentially exacerbating sequalae of hearing loss in healthcare settings.Amidst growing recognition of the need for interprofessional healthcare collaboration, this session will focus on how audiologists and hearing specialists may partner with other healthcare providers (pharmacists, nurses, physicians) to address hearing needs in primary care, specialty care and hospital settings.We will include perspectives from the United Kingdom, the United States and Canada.We will describe factors that facilitate and impede communication between pharmacists and patients with hearing loss in the community pharmacy.We will also present results of a mixed-methods study from an interdisciplinary team (gerontology, public health, audiology, and otolaryngology/ear nose throat (ENT)) to inform primary care/ENT physicians about preferences for hearing treatment among Black women in the United States.Within a hospital setting, we will present how audiologist-nurse partnerships impact delirium.We will conclude with a discussion of how policy for hearing aid coverage impacts primary care providers recommendations for hearing healthcare in the United States.

INTERDISCIPLINARY MANAGEMENT OF OLDER ADULTS WITH HEARING LOSS: POLICY MATTERS Michelle Arnold, University of South Florida, Tampa, Florida, United States
Hearing aids are an efficacious approach for treating hearing loss yet are underutilized in the US due to high outof-pocket costs.Lack of hearing aid insurance coverage is one source of the breakdown in the interdisciplinary management of older adults with hearing loss, causing hesitation among primary care providers to refer patients to audiology for treatment.Recently, access and affordability of hearing aids for adults has gained traction, with several states mandating private insurance coverage of hearing aids.The purpose of this study was to understand state-level variability in private insurance hearing aid mandates and to quantify yearly averages of the share of privately insured adults aged <65.We conducted a longitudinal policy surveillance of state statutes for mandates through January 2023.Policy data were then combined with individual-level age, insurance, state, and year variables from American Community Survey and Medical Expenditure Panel Survey Insurance Component to estimate the share of privately-insured adults covered by a mandate from 2008-2022.We identified 25 states and 1 territory with effective private insurance hearing aid mandates.There was substantial variability in these mandates, including in exceptions, maximum age eligibility, allowable frequency of benefit use, and total coverage reimbursement amount.Between 2008-2022, we estimated that <10% of privately-insured adults lived in a state with coverage.We conclude that hearing aid mandates are covering a small but growing share of Americans.A federal mandate would be the fastest way to ensure access, but states can improve access by adopting exception-free mandates with limited utilization management.

AN INTERDISCIPLINARY APPROACH TO ADDRESSING HEARING LOSS IN THE INPATIENT SETTING TO IMPROVE COMMUNICATION Nicholas Reed, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
Nearly half of all adults over 60 years of age have hearing loss which is associated with decreased satisfaction with care, higher risk of readmission, and longer length of stay.These associations may be mediated by the barriers hearing loss places on patient-provider communication.There is a paucity of sustainable programs focused on addressing hearing loss among older adults in the inpatient.An interdisciplinary collaborative team comprising audiologists, geriatricians, and nurses developed and implemented a quality initiative to address hearing loss in the inpatient setting in two medical inpatient units at Johns Hopkins Bayview Medical Center that started with offering 16 training session slots to raise awareness of hearing loss and teach technologic, environmental, and communication considerations for adults with hearing loss.Over a 3-month period, 543 of 644 admitted patients were screened for hearing loss using a sustainable model built into the admission process.Those without hearing loss (52.6%) received no intervention, those with mild loss (31.3%) received signage in the room reminding providers of training, and those with moderate or greater loss (16.1%) received signage and an amplifier.At discharge, 79% and 81.6% of those with mild and moderate hearing loss indicated improved communication during their current stay relative to previous stays.Notably, a larger proportion of those without hearing loss (52.9%) also indicated improved communication.A post study survey among 18 nurses suggested themes of moderate (33%) desiring more training and overwhelming perceptions (94.4%) the program didn't interfere with other duties and made communication with patients easier.

KNOWLEDGE, ATTITUDES, AND BELIEFS ABOUT HEARING HEALTH CARE OF OLDER BLACK WOMEN SEEKING HEARING HELP IN ENT SETTINGS Julia Toman, Charity Lewis, Victora Sanchez, and Michelle Arnold, University of South Florida, Tampa, Florida, United States
There are documented barriers to access and use of healthcare services faced by older Black adults in the US.Black women are more likely to report negative past experiences with the healthcare system and as a result have inherent mistrust of providers.Black women are also less likely to receive referrals for specialty and allied health care, but it is unknown if this trend is apparent for hearing healthcare.The purpose of the current study was to investigate the experiences of older Black women seeking help for hearing loss in an otolaryngology (ENT) clinic setting.Our interdisciplinary team consisting of experts in gerontology and Black women's health, public health, audiology, and otolaryngology conducted a mixed methods study which included (1) semi-structured interviews (n=15) and ( 2) online administration of a validated hearing beliefs questionnaire (n=86).Interview themes uncovered included experiences with racism in healthcare, the role of religion in help-seeking, and the importance of seeking treatment for hearing loss.
Triangulation of findings revealed consistency between themes and questionnaire results, including little to no expressed stigma surrounding hearing aid use and little resistance to hearing healthcare or hearing loss treatment.Our results suggest that primary care and ENT should feel confident in referring older Black women who are seeking help for hearing loss to audiology for treatment options.We will also discuss other known facilitators and barriers to serving this population in an ENT setting.

AGE-RELATED HEARING LOSS IN COMMUNITY PHARMACY: BARRIERS AND FACILITATORS TO COMMUNICATION
Penny Lewis 1 , Shanice Thomas 2 , Jane Griffiths 2 , Denham Phipps 2 , Gabrielle Saunders 2 , and Christopher Todd 2 , 1.The University of Manchester,Manchester,England,United Kingdom,2. University of Manchester,Manchester,England,United Kingdom Pharmacists have an important role in primary care, communicating with people and ensuring safe and appropriate medication use.However, inadequate communication is a barrier to the delivery of effective care for people with hearing loss.This study sought to explore factors that facilitate and impede communication with people with age-related hearing loss (presbycusis) in the community pharmacy, in order to identify solutions to improve these interactions.Online semistructured interviews with people with age-related hearing loss (presbycusis), older people (>50 years old) without hearing loss, and online focus groups and interviews with community pharmacists were conducted.Data were analysed using the framework method.Sixteen people with age-related hearing loss, three older people without hearing loss and eight community pharmacists took part.Participants described a multitude of environmental barriers to communication and person-centred pharmaceutical care such as heavy workload, lack of privacy, noise levels and Covid-19 safety measures.There was a perception among participants that their hearing loss is not relevant to the community pharmacy setting and that more could be done to signify that a pharmacy recognises the needs of those with hearing loss, furthermore, participants discussed their limited interaction with pharmacy personnel.There were varying perceptions about communication and levels of awareness among pharmacists about the key facilitators to communication.Greater interdisciplinary collaboration to develop and implement strategies/ adaptations tailored to the needs of people with hearing loss would support the engenderment of hearing-friendly community pharmacies and the safe use of medicines.

FROM CELLS TO SYSTEMS
Chair: Raya Kheirbek Co-Chair: Kenzie Latham-Mintus Individuals who have been incarcerated may experience chronic pain due to various reasons, such as physical injuries sustained during their time in prison, untreated chronic medical conditions, or addiction to prescription medications.The pain may persist into late life, resulting in reduced quality of life, increased healthcare costs, and limited access to end